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The Shrewsbury and Telford Hospital NHS Trust
Patient LFT Reporting Form
Jemima Hughes
2022-07-22T16:20:08+01:00
Patient LFT Reporting Form
Last updated: 22 July 2022 at 16:05
Patients Information
Name
*
Patients First Name
Surname
Patients Date of Birth
*
DD slash MM slash YYYY
Test Information
Unit Number
*
Lot Number of Test
*
Date Test was Taken
*
DD slash MM slash YYYY
Time Test was Taken (please use 24-hour format)
*
:
Hours
Minutes
Test Result (Please see the testing guide for details of how to interpret results shown on the device.)
*
Positive
Negative
Invalid
Patient Informed?
*
Yes
No
Test Taken By:
*
First Name
Last Name
Job Role/Title:
*
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